A new study demonstrates that flexible-fiber CO2 laser can safely cut and coagulate during endoscopic assisted transsphenoidal craniotomies (TSC), without the line-of-sight problems encountered with conventional CO2 lasers.
Researchers at Boston Medical Center (BMC; MA, USA) and Boston University School of Medicine (BUSM; MA, USA) conducted a retrospective chart review to review the utility and safety of the flexible-fiber CO2 laser in TSC surgery. In all, 16 patients were identified who underwent the laser-assisted procedure; all tumor pathology types were considered. Results were assessed based on hormone status, tumor size, pathology, complications, and resection rates.
The results showed that 16 pituitary lesions with an average size of 22.7 mm were identified by radiographic and pathologic criteria. All patients underwent flexible-fiber CO2 laser-assisted endoscopic endonasal TSC surgery. Gross total resection was achieved in 7 of 16 patients (43.75%) with hormone remission in all patients after a mean follow-up of 19.3 months. Postoperative complications occurred in three patients (18.75%), of which two patients developed transient diabetes insipidus (DI) and one developed a cerebrospinal fluid (CSF) leak requiring surgical repair. Five patients (31.25%) underwent postoperative radiation to the residual lesions. The study was published in the July/August 2011 issue of World Neurosurgery.
“Because most pituitary tumors are soft, the CO2 laser was not used extensively for tumor resection in this series, but we have found it very helpful in removing recurrent pituitary adenomas where tumor consistency is often more fibrous, and dural scarring may be extensive,” said study coauthor author Anand Devaiah, MD, an associate professor of otolaryngology and neurological surgery at BUSM.
The implementation of endoscopy in transsphenoidal surgery for pituitary tumors and other sellar lesions has been bolstered by the demonstration of its safety and relative advantages over traditional microscope-based approaches. The long wavelength of the CO2 laser has been demonstrated to have high absorption in tissue and water, with rapid conversion of light energy into heat within a small volume of tissue. This property makes the CO2 laser an excellent cutting and ablation tool, because it causes minimal thermal damage to adjacent tissue.